Abstract

Pilocarpine in the Management of Allergic Rhinosinusitis

Author(s): Theodoropoulou Lydia M, Cullen Niamh A

Issue: Jan/Feb 2026 - Volume 30, Number 1

Page(s): 32-41

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  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 1
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 2
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 3
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 4
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 5
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 6
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 7
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 8
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 9
  • Pilocarpine in the Management of Allergic Rhinosinusitis Page 10

Abstract

BACKGROUND This retrospective study addresses the question of inadequate cholinergic output in Allergic Rhinosinusitis (ARS) and the feasibility of its treatment with cholinergics. Pilocarpine, a muscarinic-receptor agonist, was administered to patients with refractory obstructive sino-nasal symptoms to improve secretion and clearance. METHODS The 22-item sino-nasal outcome test (SNOT-22) was used to identify patients with recalcitrant obstructive symptoms. Patients with SNOT-22 scores greater than 16 were treated with pilocarpine 5 mg three times a day (tid), twice a day (bid), or once a day (qd); changes of their scores were compared to those of patients who were not treated with pilocarpine. SNOT-22 was administered on presentation and at follow-up at 3 and 6 months. At 6 months of treatment, pilocarpine was discontinued. Six to nine months post-discontinuation the SNOT-22 was re-administered to assess sustainability. RESULTS Severe obstructive-type ARS was identified in 48 patients over a four-year period. Nineteen patients received pilocarpine; two discontinued treatment due to side effects; eight required dosing adjustment. SNOT-22 scores were lower in the pilocarpine-treated group at 6 months of treatment and at 6-9 months after discontinuation (p < 0.05 for both). Longitudinal SNOT-22 scores improved in the pilocarpine tid-treated sub-group at 6 months of treatment and at 6-9 months after discontinuation (p < 0.05 and < 0.01 respectively). Significant SNOT-22 decline was also reached at p < 0.1 for subjects on pilocarpine qd, but was not sustained upon discontinuation. CONCLUSIONS Pilocarpine can be useful in the treatment of refractory sino-nasal blockage. Adverse effects are frequent at 5 mg tid, but lower dosing can be effective.

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